Provider Demographics
NPI:1285663633
Name:COOK, JOE CHRISTOPHER I (MD, MPH, ATC)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:CHRISTOPHER
Last Name:COOK
Suffix:I
Gender:M
Credentials:MD, MPH, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 722354
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-8783
Mailing Address - Country:US
Mailing Address - Phone:855-343-5763
Mailing Address - Fax:704-246-3996
Practice Address - Street 1:114 BYRAM BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-9636
Practice Address - Country:US
Practice Address - Phone:601-376-9960
Practice Address - Fax:601-376-4676
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22851208VP0000X, 207LP2900X
MSAT02722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08172301Medicaid
MS08172301Medicaid